title: Long-term outcome of endoluminal gastroplication in the treatment of gastro-oesophageal reflux disease: effect of a second procedure.
abstract: OBJECTIVE
  Endoluminal gastroplication has been used with limited success for the treatment of gastro-oesophageal reflux disease (GORD). This method was used in 119 patients with GORD, and the results from short-term and long-term followup of symptoms and the use of acid suppression medication are reported. The purpose of this study was also to report on the effect of a second procedure on selected patients.
  
  
  METHODS
  The Bard EndoCinch endosuturing system was used for all procedures. Data were recorded at 3 and 12 months, and symptoms and medication use were registered by means of a telephone survey after an average of 41 months (range 27-55 months). A second procedure was carried out in 20 of the initial patients, and mean follow-up time was 39 months (range 15-51 months).
  
  
  RESULTS
  There were very few complications of the procedure. Heartburn severity score was reduced from an initial 21.4 to 12.4 (p < 0.01) and 13.4 (p < 0.01) at 3 and 12 months, respectively, corresponding to a reduction in the use of acid suppression from 8.7 doses per week (DD/w) to 4.0 (p < 0.01) and 5.6 DD/w (p < 0.01). At long-term follow-up there was a return towards baseline values for acid suppression use (6.4 DD/w, p = 0.06), whereas the heartburn severity score remained low (8.5, p < 0.01). Loss of sutures was significant, from an average of 2.51 applied sutures to 1.87 (p < 0.01) and 1.81 (p < 0.01) remaining sutures at 3 and 12 months, respectively. After the second procedure, the heartburn severity score fell from an initial 22.5 to 12.7 (p < 0.01) after 3 months and remained low at long-term follow-up (6.6, p < 0.01). The corresponding data for acid suppression use were 11.7, 3.6 (p < 0.01) and 5.2 (p < 0.01) DD/w. Number of sutures increased from an average of 2.15 sutures placed initially, with 2.65 sutures added at the second procedure, to an average of 2.80 remaining sutures (p < 0.01) at 3 months.
  
  
  CONCLUSIONS
  Endoluminal gastroplication has a significant, yet transient effect on symptom score and the use of acid suppressants in GORD patients. A selection of patients for a subsequent procedure may be of value.
authors.affiliation: Department of Gastroenterology, University Hospital of North Norway, Tromsø, Norway. eyvind.paulssen@unn.no
authors.forename: Eyvind J
authors.initials: EJ
authors.lastname: Paulssen
authors.forename: Rolv-Ole
authors.initials: RO
authors.lastname: Lindsetmo
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006356:Heartburn / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013270:Stomach / Q000601:surgery*; D013537:Sutures; D016896:Treatment Outcome